World Allergy Forum - IgE: Bench to Bedside

Anti IgE and Immunotherapy

Ulrich Wahn

The management of allergic diseases is based on
the general principles of environmental control (allergen avoidance),
pharmacologic therapy, allergen immunotherapy, and patient education.
Specific immunotherapy (SIT) can be an effective treatment for
allergic rhinitis and allergic asthma, if adequate doses of standardized
allergens are administered, with the possibility of long-term
benefits extending beyond the course of treatment. However, the
clinical effect of SIT may be incomplete in the first year of
therapy, especially in polysensitized patients.

We conducted a randomized, double-blind trial to assess the efficacy
and safety of subcutaneously administered anti-IgE (omalizumab)
or placebo in children and adolescents with seasonal allergic
rhinitis in both birch- and grass-pollen seasons (sequential seasons
lasting on average 84 days). There were 4 treatment arms. Each
subject was started on SIT-birch or SIT-grass, and anti-IgE or
placebo was started before and maintained during (total 24 weeks)
the anticipated pollen seasons. The primary efficacy variable
was symptom load, the sum of daily symptom severity score plus
rescue medication use.

The combination of specific immunotherapy and anti IgE may be
a novel strategy to further reduce symptoms and additional rhinitis
medication requirements in patients for whom specific immunotherapy
is indicated. The lack of dependence on allergen specificity makes
anti-IgE especially suitable for use in polysensitized allergic
patients.